Roots to Branches: The importance of skill from Research to Delivery of Vaccines

The vaccine industry has been supplying a large share of basic vaccines to a number of developing countries, and is now exporting more advanced vaccines as well.ETHealthWorld | Updated: April 14, 2016, 07:14 IST

The Indian vaccine industry began as a network of state-owned manufacturers, supplying basic childhood vaccines to the national immunization programme. In recent decades, the number of privately owned firms has grown rapidly. Their success in bringing low cost solutions to public vaccine markets is an important driver behind the emergence of the sector in India. With increasing revenues and advancement in technology, the companies are increasingly shifting their focus on innovation.

The vaccine industry has also been supplying a large share of basic vaccines to a number of developing countries, and is now exporting more advanced vaccines as well. From a public health perspective, it is a significant contribution that our industry has made, by bringing down prices and keeping them low. Even though price will continue to play an important role, the industry is now in a translational phase, moving from a ‘price’ driven to an ‘innovation’ driven model.

Currently, a dozen or so new vaccines are in clinical development in India. According to a 2013 report of the Netherlands Office of Science and Technology entitled ‘Vaccines Market in India’, the disease areas being worked on by vaccination experts are - Rotavirus, Japanese Encephalitis, Typhoid fever, Malaria, Rabies, and Influenza, amongst others. According to the report, many other projects were also in earlier stages of research, including efforts on Dengue, Chikungunya and Cholera.

The Indian government supports such initiatives through growing investment in research and development (R&D). Relevant government funding agencies like the Department of Biotechnology, The Indian Council of Medical Research and Ministry of Health and Family Welfare have been scaling up their investments in R&D. Government is actively supporting the emergence of R&D in the private sector through joint investment in Public-Private Partnerships (PPPs). PPP’s are at the heart of many of the industries’ recent R&D successes which is why our Government is now taking an active interest in vaccines and immunization.

In terms of R&D, there have been particular focus areas for vaccines. Listed below are some that have been of primary concern to our organization with its aim of creating safe, low-cost vaccines that are highly effective and can be easily incorporated into child immunization programmes:

• Thermostability- The vaccine should be room temperature stable with a stability profile that meets the needs of developing countries • Ease-of-use- The vaccine should be easy to administer in field settings and limit biological waste • Package size- The vaccine should be packaged in a manner that is easy to transport, store and administer • Reduced cost of goods- The vaccine production cost by manufacturers should be affordable for use in developing countries

These focus areas of R&D form effective strategies for protecting individuals from vaccine-preventable diseases. It is important to account for all stages in a vaccination process so as to maintain the right level of skill from the beginning to the end, which is why the following strategies are also crucial:

• Develop new or improved vaccines and improve the use of vaccines • Improve both the quality and quantity of the delivery of vaccination services • Minimize financial burdens for needy persons • Increase community awareness, participation, education, and partnership • Improve disease monitoring and vaccination coverage

While there is plenty of skill and knowledge that can be found in India in the R&D stage of vaccines, the availability of skill decreases as one proceeds down the delivery chain. Skill plays an equally important role in the delivery and administration stage of a vaccination process, especially in remote and rural areas in developing nations. India’s health system is complex, and at its grassroots are people such as the Auxiliary Nurse Midwife (ANM), Accredited Social Health Activist (ASHA) and Anganwadi Workers (AWW) who serve at the frontiers between disease and health. For immunization programmes to be successful, their role is critical.

Vaccinators are therefore in a unique position to identify populations who form a target group for certain vaccinations. They are one of the most accessible health care professionals as they are instrumental in providing patients with pertinent information to make informed choices when it comes to immunizations. They may also be able to ease the fears of many patients by providing them with the facts as well as the significant risks associated with not being vaccinated.

Since not all vaccines are administered in the same way, the level of expertise differs with programmes and diseases. Which is why, vaccinators should be adjudged to administer based on different criteria. The criteria can be anywhere from specific education to certification requirements before administering a vaccine.

India, however, is in need of an educational programme that teaches vaccinators the skills needed to become a primary provider for both vaccine education and administration. The programme should be such that it teaches the basics of vaccines and focuses on both the practice implementation and societal/ethical issues with regard to vaccinations.

In rural areas health administrators who do not administer vaccines also have an important role in promoting the importance of immunization which includes:

(1) history and screening of patients,(2) patient counseling,(3) documentation,(4) formulary management,(5) administrative measures, and(6) public education and awareness. Effectively all these measures serve one common purpose; that of bringing health to individuals who are at the danger of falling prey to deadly diseases and who can be important contributors to a nation which is still in its development stage.

(The author is the CEO of Hilleman Laboratories, New Delhi, an equal joint-venture partnership between Merck & Co. and Wellcome Trust.)

With immense pride “India Live” celebrated its 10th national conference in Mumbai from 28th February to 3rd March 2019. The conference turned out to be a gold mine of information, with emphasis on academics, education and exchange of knowledge with leaders in interventional cardiology from both India and abroad.